Improving First-hour Breastfeeding Initiation Rate After Cesarean Deliveries: A Quality Improvement Study

Objective: To improve the rates of first hour initiation ofbreastfeeding in neonates born through cesarean section from 0to 80% over 3 months through a quality improvement (QI)process.Design: Quality improvement study.Setting: Labor Room-Operation Theatre of a tertiary carehospital.Participants: Stable newborns ?35 weeks of gestation born bycesarean section under spinal anesthesia.Procedure: A team of nurses, pediatricians, obstetricians andanesthetists analyzed possible reasons for delayed initiation ofbreastfeeding by Process flow mapping and Fish bone analysis.Various change ideas were tested through sequential Plan-Do-Study-Act (PDSA) cycles.Outcome measure: Proportion of eligible babies breast fedwithin 1 hour of delivery.Results: The rate of first-hour initiation of breastfeeding increasedfrom 0% to 93% over the study period. The result was sustainedeven after the last PDSA cycle, without any additional resources.Conclusions: A QI approach was able to accomplish sustainedimprovement in first-hour breastfeeding rates in cesareandeliveries.

Childhood Morbidity and Mortality in India – Analysis of National Family Health Survey 4 (NFHS-4) Findings

National Family Health Survey (NFHS)-4 report was recently released for health-related data. This review compares the child healthindicators across NFHS-3 and NFHS-4 with a background of existing health programs catering to child health. Reports of NFHS-4 andNFHS-3, along with ministry reports and existing literature were reviewed to understand the current status of child health. Child healthindicators were compared between the two rounds of NFHS and among Empowered Action Group states of India. National Health Policy2017 and National Health Programs related to child health were also analyzed. There has been an improvement in almost all child healthindicators from NFHS-3 to NFHS-4. The infant mortality rate has reduced to 41 per 1000 live births. The immunization rate is 62%, andhas almost doubled in the states of Uttar Pradesh, Rajasthan and Madhya Pradesh. Despite existence of many health programs, there isstill a substantial lack of achievement in most of the indicators.a